﻿@model Adams.Web.Areas.MyAdams.Models.Profile.CreditCard.PageLoad
@{
    Layout = "~/Views/Shared/_MembershipLayout.Mobile.cshtml";
}
@section Head{
}
<h1>
    My Credit Card</h1>
<div id="form">
    <div id="notif">
    </div>
    <h2>
        Billing Information</h2>
    <div class="form-left">
        <div class="form-text">
            Title:</div>
        <div class="form-right">
            <select id="Title" class="option" name="Title">
                <option value=""></option>
                <option value="Dr.">Dr.</option>
                <option value="Mr. & Mrs.">Mr. & Mrs.</option>
                <option value="Mr.">Mr.</option>
                <option value="Mrs.">Mrs.</option>
                <option value="Ms.">Ms.</option>
            </select>
            <input type="hidden" id="TitleDefault" value="@Model.CreditCard.Title" />
        </div>
    </div>
    <div class="form-left">
        <div class="form-text">
            <span class="required">*</span>First Name:</div>
        <div class="form-right">
            <input type="text" class="input" id="FirstName" name="FirstName" value="@Model.CreditCard.FirstName" />
        </div>
    </div>
    <div class="form-left">
        <div class="form-text">
            <span class="required">*</span>Last Name:</div>
        <div class="form-right">
            <input type="text" class="input" id="LastName" name="LastName" value="@Model.CreditCard.LastName" />
        </div>
    </div>
    <div class="form-left">
        <div class="form-text">
            <span class="required">*</span>Street:</div>
        <div class="form-right">
            <input type="text" class="input" id="Street" name="Street" value="@Model.CreditCard.Street" />
        </div>
    </div>
    <div class="form-left">
        <div class="form-text">
            Street 2:</div>
        <div class="form-right">
            <input type="text" class="input" id="Street2" name="Street2" value="@Model.CreditCard.Street2" />
        </div>
    </div>
    <div class="form-left">
        <div class="form-text">
            <span class="required">*</span>City:</div>
        <div class="form-right">
            <input type="text" class="input" id="City" name="City" value="@Model.CreditCard.City" />
        </div>
    </div>
    <div class="form-left">
        <div class="form-text">
            <span class="required">*</span>State:</div>
        <div class="form-right">
            <select id="State" class="option" name="State">
                <option value="AL">Alabama</option>
                <option value="AK">Alaska</option>
                <option value="AZ">Arizona</option>
                <option value="AR">Arkansas</option>
                <option value="CA">California</option>
                <option value="CO">Colorado</option>
                <option value="CT">Connecticut</option>
                <option value="DE">Delaware</option>
                <option value="DC">District Of Columbia</option>
                <option value="FL">Florida</option>
                <option value="GA">Georgia</option>
                <option value="HI">Hawaii</option>
                <option value="ID">Idaho</option>
                <option value="IL">Illinois</option>
                <option value="IN">Indiana</option>
                <option value="IA">Iowa</option>
                <option value="KS">Kansas</option>
                <option value="KY">Kentucky</option>
                <option value="LA">Louisiana</option>
                <option value="ME">Maine</option>
                <option value="MD">Maryland</option>
                <option value="MA">Massachusetts</option>
                <option value="MI">Michigan</option>
                <option value="MN">Minnesota</option>
                <option value="MS">Mississippi</option>
                <option value="MO">Missouri</option>
                <option value="MT">Montana</option>
                <option value="NE">Nebraska</option>
                <option value="NV">Nevada</option>
                <option value="NH">New Hampshire</option>
                <option value="NJ">New Jersey</option>
                <option value="NM">New Mexico</option>
                <option value="NY">New York</option>
                <option value="NC">North Carolina</option>
                <option value="ND">North Dakota</option>
                <option value="OH">Ohio</option>
                <option value="OK">Oklahoma</option>
                <option value="OR">Oregon</option>
                <option value="PA">Pennsylvania</option>
                <option value="RI">Rhode Island</option>
                <option value="SC">South Carolina</option>
                <option value="SD">South Dakota</option>
                <option value="TN">Tennessee</option>
                <option value="TX">Texas</option>
                <option value="UT">Utah</option>
                <option value="VT">Vermont</option>
                <option value="VA" selected="selected">Virginia</option>
                <option value="WA">Washington</option>
                <option value="WV">West Virginia</option>
                <option value="WI">Wisconsin</option>
                <option value="WY">Wyoming</option>
            </select>
            <input type="hidden" id="StateDefault" value="@Model.CreditCard.State" />
        </div>
    </div>
    <div class="form-left">
        <div class="form-text">
            <span class="required">*</span>Zip:</div>
        <div class="form-right">
            <input type="text" class="input" id="ZipCode" name="ZipCode" value="@Model.CreditCard.ZipCode" />
        </div>
    </div>
    <div class="form-left">
        <div class="form-text">
            <span class="required">*</span>Phone:</div>
        <div class="form-right">
            <input type="text" class="input" id="Phone" name="Phone" value="@Model.CreditCard.Phone" />
        </div>
    </div>
    <div class="clear">
    </div>
    <h2>
        Payment Information</h2>
    <div class="form-left">
        <div class="form-text">
            <span class="required">*</span>Card Holder's Name:</div>
        <div class="form-right">
            <input type="text" class="input" id="CardHolderName" name="CardHolderName" value="@Model.CreditCard.CardHolderName" />
        </div>
    </div>
    <div class="form-left">
        <div class="form-text">
            <span class="required">*</span>CardNumber:</div>
        <div class="form-right">
            <input type="text" class="input" id="CardNumber" name="CardNumber" />
        </div>
    </div>
    <div class="form-left">
        <div class="form-text">
            <span class="required">*</span>Card Type:</div>
        <div class="form-right">
            <select id="CardType" class="option" name="CardType">
                <option value=""></option>
                <option value="Amex">American Express</option>
                <option value="Discover">Discover</option>
                <option value="Mastercard">Mastercard</option>
                <option value="Visa">Visa</option>
            </select>
            <input type="hidden" id="CardTypeDefault" value="@Model.CreditCard.CardType" />
        </div>
    </div>
    <div class="form-left">
        <div class="form-text">
            <span class="required">*</span>Expires On:</div>
        <div class="form-right">
            <select id="CardExpireMonth" class="option" name="CardExpireMonth">
                <option value="">Month</option>
                <option value="1">01</option>
                <option value="2">02</option>
                <option value="3">03</option>
                <option value="4">04</option>
                <option value="5">05</option>
                <option value="6">06</option>
                <option value="7">07</option>
                <option value="8">08</option>
                <option value="9">09</option>
                <option value="10">10</option>
                <option value="11">11</option>
                <option value="12">12</option>
            </select>
            <input type="hidden" id="CardExpireMonthDefault" value="@Model.CreditCard.CardExpireMonth" />
            <select id="CardExpireYear" class="option" name="CardExpireYear">
                <option value="">Year</option>
                @{
                    int year = DateTime.Now.Year;
                }
                @for (int i = 0; i < 10; i++)
                {
                    <option value="@year">@year</option>
                    year++;
                }
            </select>
            <input type="hidden" id="CardExpireYearDefault" value="@Model.CreditCard.CardExpireYear" />
        </div>
    </div>
    <div class="form-left">
        <div class="form-text">
            <span class="required">*</span>Security Code:</div>
        <div class="form-right">
            <input type="text" class="input" id="CardSecurityCode" name="CardSecurityCode" />
        </div>
    </div>
    <div class="form-left">
        <div class="form-text">
            &nbsp;</div>
        <div class="form-right">
            <a href="#">
                <img src="/Content/Images/submit.jpg" alt="Submit" border="0" id="submit" /></a></div>
    </div>
    <div class="clear">
    </div>
    <input id="ReturnTo" type="hidden" value="@Model.ReturnTo" />
</div>
@section Scripts {
    <script src="/Areas/Membership/Scripts/Profile/creditcard.js" type="text/javascript"></script>
}
